C‑sections are a vital part of modern maternity care. They save lives, they can offer safety and clarity in unpredictable situations, and for many people, they’re a welcome and empowering choice. The problem isn’t with the procedure itself—it’s with the systems that lead too many people into having one by default, not by design.

In the UK, around 42% of births are now by caesarean—one of the highest rates in Europe [1]. In France, by comparison, it’s just 19% [2]. That difference alone isn’t necessarily a cause for concern—rates vary for many reasons—but it becomes more concerning when we consider that the UK has significantly more emergency C-sections than France. And that tells us something about how the system is functioning.

So why is this happening?

It’s not because more people are choosing elective caesareans. A Lancet review found that the rise in global C-section rates isn’t driven by women requesting surgery, but by systems becoming more skilled in surgical births than in physiological ones [3]. In other words, it’s not a case of demand—it’s a reflection of how our systems are designed.

In the UK, most women do want a vaginal birth. But they want a positive one—where they feel safe, supported, and listened to. While no system can promise a specific birth outcome, it should be able to guarantee dignity, continuity, and good communication. Too often, the NHS can’t deliver that. Understaffing, time pressure, and fragmented care mean people feel rushed, unheard, and pushed towards interventions they may not have needed in a different context.

Compare that to countries like France and Germany, where maternity systems are structured to support relationship-based care and thorough preparation. France offers around seven antenatal education workshops as standard. In Germany, pregnant people can access 12 sessions of non-medical antenatal care with the same independent midwife—on top of medical checkups [4][5]. In the UK, antenatal care often consists of 12 short appointments, typically 20 minutes long, with little time for deeper questions or emotional preparation. In practice, that means about one hour total across the whole of pregnancy to ask anything outside the basics.

Elective C-sections are a valid choice—when there’s a real choice

We should always support people who choose an elective C-section. For many, it’s the right decision and can be a calm, controlled experience. But we need to ensure that decision is being made between two positive options—not between uncertainty and control, or fear and safety.

If vaginal birth is going to remain the default recommendation, then the system has to make it feel like a safe, supported, and realistic path. That’s not always the case at the moment, and it's one reason we see so many unplanned or unwanted surgical births.

A few ways to reduce the likelihood of emergency C-section

Of course, not all C-sections can or should be avoided. But some key changes and supports can help reduce the likelihood of emergency surgery:

• Consider a home birth, especially for low-risk pregnancies—rates of intervention are lower, and outcomes are equivalent or better [6].
• Work with a doula or independent midwife, someone who knows you and can support you across your whole pregnancy and labour.
• Stay at home as long as feels safe during early labour, where you’re more likely to move freely and stay relaxed.
• Prioritise antenatal education—learn how your body works in labour, what your choices are, and how to advocate for yourself if things change.

In summary

The issue isn’t the C-section—it’s how we get there. Too many people in the UK are ending up in surgery not by choice, but by default. If we want to see better outcomes, we need to look at what other countries are doing differently: investing in midwifery, continuity, preparation, and time.

We should be building a system where every birth—surgical or vaginal—is supported, informed, and truly chosen.

Sources
[1] NHS Maternity Statistics, England 2023–24.
[2] Euro-Peristat Project: France C-section rates, 2022.
[3] The Lancet (2018). Stemming the global caesarean section epidemic.
[4] Haute Autorité de Santé (France). Guide de la maternité.
[5] Deutscher HebammenVerband: Hebammenhilfe während der Schwangerschaft.
[6] Birthplace Study (NPEU, 2011): Outcomes for planned home births vs hospital births.